Is your graduate nurse suffering from transition shock?

The term 'transition shock' is a relatively new concept used to describe the experience of moving from the comfortable and familiar role of the preregistration nursing student to the professional registered nurse (RN)1. The initial and most dramatic stage in this theory of role adaption occurs over the first four months of professional practice1. Transition shock has foundational basis in Kramer's theory of 'reality shock,' which describes the phenomenon of studying for many years to practice a particular role, and then finding the professional reality is different than expected2. Reality shock has four phases - the honeymoon phase, the shock phase, recovery and resolution. Dr Judy Duchscher's theory of transition shock penetrates beyond the professional aspects of shock1. Duchscher, whose research into this issue in nursing spans over ten years, states that 'nurses often identify their initial professional adjustment in terms of the feelings of anxiety, insecurity, inadequacy and instability it produces1.' Few would argue that the first few months of a graduate RN's career are the most stressful3 - consolidating the theory outlined by Kramer. This paper seeks to define transition shock and outline signs and symptoms which may be exhibited by the graduate nurse. Potential solutions to mitigate the effects of the shock phase on the perioperative graduate will be extrapolated. It is hoped that perioperative nurses will have an improved ability to recognise the issue and, with greater awareness and understanding, potentially be able to improve support for perioperative graduates to ensure a smooth path to successful transition and, in the long term, increase retention of graduates in the profession. In offering solutions, the logistical issues affecting education and support in the operating theatre are highlighted and issues for potential research are recognised.